Title Page
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Confined space
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Conducted on
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Prepared by
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Space Name/ Location/ Department
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Pic of Confined space
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Is bodily entry possible?<br>
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Limited or restricted access/ egress?<br>
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Not desinged for continuous human occupancy?<br>
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If yes to all 3 above it is a confined space.
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Potential/ actual hazardous atmoshphere?<br>
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Potential for engulfment?
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Internal configuration may trap or asphyxiate entrant?<br>
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Other safety or health hazard present?
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If yes to any of the 4 above permit is required
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Type of Space? Permit/ Non-Permit<br>
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Sign
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Bolted shut
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Cannot enter
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Training
